Handler Application

It is the mission of Cover Six Canines to assist Veterans and 1st Responders in the training of their service dog at no cost to the Veteran or 1st Responder.

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Handler Application

Full Name

Full Name

Email

Phone Number

Phone number where we can reach you

Address Line 1

Address Line 2

City

State

Zip Code

Are you a Veteran or active duty?

Yes
No

If you are a Veteran which branch?

Are or were you a First Responder?

Yes
No

If you are or were a First Responder which type?

Do you have or can you obtain proof of service such as DD214 or letter from agency?

Yes
No

Has a doctor diagnosed you with a disability?

Yes
No

What is your disability/disabilities?

Has or will a doctor write a letter stating that you would benefit from a Service Dog?

Yes
No

Do you currently have a dog?

Yes
No

If you plan on using this dog, what is the age and breed?

What specific, trained tasks does your dog currently perform, or need to perform, to assist with your disability?

Who lives with you?

Do you currently work?

Full Time
Part Time
Don't Work

Have you previously trained with any other organization? If so who?